Clinical Approach to the Child with Scoliosis
Marilyn C. Jones MD1
1 Assistant Professor of Pediatrics, University of California, San Diego; Director Dysmorphology and Genetics, Children's Hospital of San Diego, 8001 Frost St, San Diego, CA 92123
Although most children with scoliosis are otherwise structurally normal, spinal curvature may represent one feature in a broader problem of altered development with a specific prognosis and a specific risk of occurrence in siblings and children of the affected individual. A clinical approach to the evaluation of the child with scoliosis is proposed based upon the age of recognition of the curvature and a detailed physical examination.
Scoliosis is defined as a lateral curvature of the spine. In contrast to curves in the anteroposterior dimension (kyphosis and lordosis), scoliosis is never present in the normal spine. Although mild degrees of curvature are often asymptomatic, marked scoliosis produces severe disability and shortens lifespan by interfering with pulmonary mechanics, resulting in hyperventilation, pulmonary hypertension, and eventually, pulmonary and cardiac failure. Early diagnosis and promptly instituted treatment are effective in reducing long-term morbidity. It is critical to recognize that scoliosis is not a diagnosis. It is a description of a particular structural alteration which may be produced by a variety of pathogenetic mechanisms and which has many different etiologies. The vertical stability of an individual is maintained as a consequence of normal vertebral bodies, intervertebral disks, ligamentous and muscular attachments, and normal neuromuscular function. Alteration in any one of the above may lead to scoliosis.
